Healthcare Provider Details

I. General information

NPI: 1619945060
Provider Name (Legal Business Name): WILLIAM CRIT MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 05/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 HUNTERS MEADOW DR
LORENA TX
76655-3539
US

IV. Provider business mailing address

355 HUNTERS MEADOW DR
LORENA TX
76655-3539
US

V. Phone/Fax

Practice location:
  • Phone: 254-644-4966
  • Fax: 254-732-0483
Mailing address:
  • Phone: 254-644-4966
  • Fax: 254-732-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberJ4360
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ4360
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: